Connected for Warmth Application

Occupant Details

Name *

Address *

Postcode *

Home Tel *

Mobile Tel *

Date of Birth *

Secondary Contact

(Who you authorise us to speak to about your request on your behalf).

What is the tenure of Your Property? *

Landlord Details

Name

Address

Postcode

Home Tel

Mobile Tel

What type of home do you have? *

Additional Details?

Is your Property a Listed Building? *

What is the style of your home? *

How many storeys does your home have? *

How many bedrooms does your home have? *

Number of Adult occupants *

Number of Children (under 18 years old) occupants *

Does your property have a gas connection? *

What is your main heating system? *

What does your main heating use? *

Additional Details?

How do you heat hot water? *

Additional Details?

How much is your total ANNUAL energy spend?

How much is your total MONTHLY energy spend?

Who is your Current Energy Supplier?

What is the current Energy Performance Certificate Rating (EPC) for your home? *

Do you have an airing cupboard or sufficient space for a hot water cylinder? *

Additional Details

Do you have sufficient space for an air source heat pump? *

Are the walls in your property insulated? *

Is the roof / loft of your property insulated? *

Current Household income *

This comprises income from all sources, such as a net earnings (after tax) income from savings and investments, Pensions, all benefits (including housing benefits).

Do you receive any of the following benefits? *

Please write the Reference Number / National Insurance Number for the benefit

Do you receive any of the following support? *

Does anyone in your household suffer from any health conditions exacerbated by the cold? *

Additional Details?

Does anyone in your household have any additional heating needs? *

Additional Details?

Householder Statement

I confirm that the information I have provided is to the best my knowledge correct. I give permission for the information contained in this form to be used by Plumb-Line Contracting Ltd and its partners named in the introduction letter, for the purposes of this project. The information will be held in accordance with the General Data Protection Regulation (GDPR) 2018 and successor legislation as well as the Data Protection Act of 1998.

Householder Signature (type your full name) *

Date *

Consent form for sharing data with The Energy Saving Trust

We need to check that you are eligible for the Energy Company Obligation (ECO) Scheme. To do this, we would like to share your information with the Department for Work and Pensions (DWP) via the Energy Saving Trust (EST) who will verify whether or not you are receiving the relevant benefit(s) to be eligible for the ECO scheme.

Please note that it is not possible for EST or us, the company using this service, to see which benefits you are on through this service. The DWP will only confirm whether you are in receipt of an ECO qualifying benefit, not which one. This will not have any impact on future benefit payments.

If you do not want us to share your data with EST, you will be required to provide copies of documents that provide proof of the benefits you are in receipt of from the DWP.

For full information on what will happen to the data we will collect about you, please see the privacy notice on our website https://plumb-line.co.uk/privacy-notice/

By ticking the box below and providing your details, you agree to share your details with the DWP via EST.

You can contact us to withdraw your consent for us to share your data with EST. If you withdraw consent, the collected data will continue to be processed, however no new data will be collected or used for further processing.

I agree to my information provided (below) being shared with the Department of Work and Pensions via the Energy Saving Trust to confirm whether I am in receipt the relevant benefit(s) to be eligible for the ECO scheme *

Title *

First Name *

Last Name *

Date of Birth *

Type of Customer *

Additional Details?

Address *

Postcode *

Telephone *

Email Address *

Preferred Contact Method *

Signature (type your full name) *

Date *

Energy Saving Trust

Datamatch service for ECO4 https://datamatch.est.org.uk

Effective from 01 April 2022

4 + 4 = ?Please prove that you are human by solving the equation *

“Cannot speak more highly of the company.”

Customer in Northampton, November 2021

Connected for Warmth Application

Occupant Details

Secondary Contact

Landlord Details

Householder Statement

Consent form for sharing data with The Energy Saving Trust

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